Recommendations and treatment of arterial hypertension
The USPSTF expert group recommended a routine measurement of blood pressure in all adults. JNC-7 recommendations identify four levels of BP according to risk. JNC-7 intervention guidelines are based on levels of blood pressure and absolute risk. Absolute risk stratification is carried out according to the presence or absence of POM, clinical CVD, DM or cardiovascular RF, such as smoking, dyslipidemia (DLP), age> 60 years, gender, early CVD in the family history. JNC-7 recommendations set a target blood pressure level of <140/90 mmHg. st. for patients with low risk and <130/80 mm Hg. st. – for those suffering from CVD, diabetes or chronic kidney disease.
Since the association of blood pressure with a cardiovascular risk is straightforward, a significant part of the population attributable risk is in people with blood pressure, who, according to JNC-7, are classified as prehypertension, AAD = 120–139 mm Hg. Art., and DBP = 80-89 mm Hg. st.
For all persons with blood pressure> 120/80 mm Hg. st. JNC-7 recommends lifestyle changes, including smoking cessation, weight loss, if necessary, increasing FA, limiting alcohol and salt, maintaining adequate intake of potassium and calcium, using the DASH dietary strategy, i.e. diets with a reduced content of saturated fatty acids and total fat, but rich in fruits, vegetables, and low-fat dairy products.
The initiation of drug therapy depends on the levels of blood pressure and absolute risk. For example, for people with hypertension I degree, but without signs of organ damage, vascular disease or diabetes, and with a cardiovascular risk factor alone, lifestyle changes and drug therapy are recommended. For persons with hypertension of II degree, a combined initial therapy, usually including diuretics, is necessary. The guide also recommends starting therapy with two drugs, one of which is a diuretic, when blood pressure is above the target level at> 20/10 mm Hg. st. The specific therapeutic drugs recommended by JNC-7 are discussed in detail in a separate article on the site – we recommend using the search form in the sidebar of the site menu.
For most patients, more than one drug is required to reach the target level.
The European Society of Cardiology guidelines have otherwise stratified initial therapy. High normal blood pressure is determined when GAD = 130-139 mm Hg. st. or DBP = 85-89 mm Hg. Art., and drug therapy is recommended only for this group of patients if they have a very high risk due to a history of MI, TIA or a similar clinical condition. Among patients with hypertension I degree (CAD = 140-159 mm of rg. Art. Or DBP = 90-99 mm Hg. Art.) Or hypertension of II degree (CAD = 160-179 mm Hg. Or DAD = 100-109 mmHg. Drug therapy should be started immediately for people at high risk (RF> 3, POM or DM) or at very high risk (obvious clinical disease).
For patients of the other two groups (with moderate and low risk), a lifestyle change with continuous monitoring (at least 3 months) is recommended. If the CAD is still> 140 mmHg. st. or dad> 90 mm Hg. Art. Drug therapy should be prescribed to patients at moderate risk and should be considered for those at low risk. As with the JNC-7 recommendations, lifestyle changes should always be recommended as an adjunct to drug therapy.
The results of ALLHAT also showed that a thiazide-like diuretic can be a good choice as an initial antihypertensive therapy (AGT). The use of β-AB for primary prophylaxis as a first-line therapy has been carefully studied. The ASCOT-BPLA study included 19,257 patients with hypertension and a moderate risk of developing SSSob. The patients were divided into 2 groups:
(1) β-AB plus thiazide diuretic (if necessary);
(2) prolonged calcium antagonist plus ACE inhibitors (if necessary).
The study was terminated ahead of time, because it became apparent that over time, those taking β-AB fell into disadvantage. A meta-analysis of 20 studies showed that β-AB should not remain the drug of first choice in the treatment of primary hypertension.
In 2006, the British Hypertension Society revised the recommendations on drug therapy ahead of time to change the previous recommendations on β-AB as first-line drugs for the treatment of hypertension. The working group presented evidence that β-AB is not as effective as other drugs, especially in the elderly, and drew attention to the increasing evidence that β-AB in usual doses create an unacceptable risk of developing diabetes-2.